[Glomerular disease and living donor kidney transplantation]

Area of Science:

• Nephrology
• Transplantation Immunology
• Pathology

Context:

• Glomerular diseases significantly contribute to mid-to-long term renal transplant graft failure.
• Primary disease recurrence is the main driver of graft loss post-transplantation.
• Living donor kidney transplantation presents unique risks, including disease recurrence and de novo glomerular disease in donors due to genetic similarity.

Purpose:

• To highlight the impact of glomerular diseases on renal transplant outcomes.
• To discuss the specific challenges posed by glomerular diseases in living donor transplantation.
• To emphasize the diagnostic role of renal biopsy in post-transplant glomerular disease.

Summary:

• Glomerular diseases frequently cause renal transplant graft loss, primarily through recurrence of the original disease.
• The incidence of recurrence varies by glomerular disease type, with IgA nephropathy and type II membranous proliferative glomerulopathy being particularly common.
• Distinguishing between histological and clinical recurrence is vital, as histological recurrence is more frequent.
• Renal biopsy, especially with immunofluorescence, is essential for diagnosing and classifying post-transplant glomerular diseases.

Impact:

• Understanding recurrence patterns aids in risk stratification and patient management.
• Accurate diagnosis through renal biopsy improves therapeutic strategies and graft survival.
• Highlights the importance of donor evaluation in living donor transplantation to mitigate genetic risks.